The Impact of Awe on Existential Isolation: Evidence for Contrasting Pathways.

We propose that awe has multifaceted relations with existential isolation, a feeling of separation between the self and others or the world. Three studies examined the relation between awe and existential isolation via feelings of small self (vastness, self-size, self-perspectives) and a sense of connectedness. Awe (vs. a control topic) was induced either using virtual reality (Study 1) or a recall task (Studies 2 and 3) and was indirectly associated with higher and lower levels of existential isolation through differing pathways. Awe was associated with lower feelings of existential isolation via an increased sense of vastness, which in turn predicted greater connectedness; whereas awe was associated with higher feelings of existential isolation via increased sense of feeling small, which in turn predicted lower connectedness. This work advances understanding of the complex nature of awe-revealing its competing effects on the self and the social connectedness pathways through which awe can influence existential isolation.

The effect of mindfulness interventions on stress in medical students: A systematic review and meta-analysis.

BACKGROUND: Medical students have high levels of stress, which is associated with higher incidents of burnout, depression, and suicide compared to age-matched peers. Mindfulness practices have been shown to reduce stress among medical students. PURPOSE: The purpose of this systematic review and meta-analysis was to examine if mindfulness interventions have an overall effect on stress outcomes in the high-stress population of medical students globally, particularly given the wide variety of interventions. Any intervention designed to promote mindfulness was included. METHODS: A comprehensive literature search was completed to include multiple databases, ancestry, and hand-searching and 35 studies were included. Standardized mean difference effect sizes (ES) were synthesized across studies using a random-effects model for changes in stress levels in medical students ≥ 18. Moderator analyses were performed to explore variations in effects by participant and intervention characteristics. RESULTS: Mindfulness interventions significantly improved stress among medical students in both the two-arm studies (d = 0.370, k = 19, n = 2,199, 95% CI 0.239-0.501, p < .001) and one-arm pre-post studies (d = 0.291, k = 30, n = 18 (two cohorts from Dyrbye et al), 95% CI 0.127-0.455, p = 0.001). Moderator analyses found trends in less hours and less required practice resulted in better improvement in stress. CONCLUSIONS: This study further confirms that despite a wide variety of mindfulness interventions for medical students around the world, they produce an overall small-to-moderate effect on stress reduction. Future research looking at the most effective protocols for high-stress medical students would be beneficial.

Prevalence, characteristics and measurement of somatic symptoms related to mental health in medical students: a scoping review.

INTRODUCTION: Somatic symptoms related to mental health in medical students are under-researched, with nothing on the topic being published in the United States in over three decades. This scoping review is the first of its kind to explore the prevalence, type and severity of somatic symptoms induced by stress, anxiety, depression and burnout amongst medical students, with the objective of describing the significance and breadth of this issue. METHODS: PRISMA-ScR guidelines were used to guide this review. A comprehensive search was performed of 22 databases, followed by bibliographic and hand searching. Inclusion criteria were published, peer-reviewed articles with a sample of medical students and at least one measure of somatic symptoms related to mental health, in English or with an English-language translation. Excluded were review, companion and editorial articles. Coding was done by an experienced coder trained in systematic review techniques. Two authors reviewed each article. RESULTS: Twenty-nine articles met inclusion criteria, representing 16 countries, 31 schools/teaching hospitals and 9,887 medical students. The prevalence of somatic symptoms ranged from 5.7 to 80.1%, and somatic symptoms were overwhelmingly found to be significantly correlated with mental ill-health. Somatic symptoms included back pain, neck pain, headaches, sleep disturbances and functional gastrointestinal disorders. Eleven different outcome measures were used, with varying degrees of validity and reliability, which were compared and assessed. CONCLUSIONS: Somatic symptoms appear strongly correlated with mental ill-health in medical students, and are likely highly prevalent. This review highlights the need for further research on somatic symptoms of mental ill-health in medical students, particularly in the United States, and the addition of larger, multi-institutional cohorts to expand our understanding of prevalence, incidence and inciting factors of somatic symptoms. Longitudinal studies tracking somatic symptoms' effect on career trajectory and professional burnout levels are also needed. Finally, future research should explore interventions for reducing physical symptom burden in medical students.

This scoping review is the first of its kind to explore the breadth and depth of knowledge on the presence, prevalence, type and severity of somatic symptoms related to stress experienced by medical students across the globe, and if or how physical symptoms of stress have been addressed thus far.Medical students are known to have chronically high levels of stress, but somatic symptoms of stress are not well researched in this population, particularly in the United States, where no research has been done on this topic in over three decades.This scoping review finds that across many different countries, medical students consistently report high rates of physical symptoms, including musculoskeletal pain and gastrointestinal disorders, which are highly correlated with stress and other mental health conditions.This review provides the first initial assessment of the outcome measures used for somatic symptoms related to mental health.Further research on the impact of physical symptoms in medical students, and how this might relate to medical students' mental health and eventual career burnout, is warranted.

Evaluating depression anxiety and stress assessment before and during the COVID-19 pandemic using generalisability theory.

The current study investigated the assessment of depression, anxiety, and stress during normal and COVID-19 pandemic conditions. Generalisability theory (G-theory) was applied to examine stable and dynamic aspects of psychological distress and the overall reliability of the Depression, Anxiety and Stress Scales (DASS-21), using data from two independent samples collected on three occasions with 2- to 4-week intervals. The US data (n = 115) was collected before the COVID-19 pandemic, and the New Zealand (NZ) data (n = 114) was obtained during the pandemic. The total DASS-21 demonstrated excellent reliability in measuring enduring symptoms of psychological distress (G = .94-.96) across both samples. While all DASS-21 subscales demonstrated good reliability with the pre-pandemic US sample, the subscales' reliability was below an acceptable level for the NZ sample. Findings from this study indicate that the overall psychological distress is enduring and can be reliably measured by the DASS-21 across different conditions and populations, while shifts across depression, anxiety and stress levels are likely during emergency and uncertainty, as seen in the COVID-19 pandemic.

Testing of Journal Writing for Symptom Concordance in Adults with Multiple Sclerosis.

BACKGROUND: Adults with multiple sclerosis (MS) experience many complex symptoms. However, research is lacking on the best method to record their symptom experience. The primary goal of this study was to test the feasibility of journal writing to capture the description of core symptoms experienced by adults with MS. A secondary goal was to collect self-report symptom data to assess concordance between the journal entries and MS-Related Symptom Checklist (MS-RS) scores. METHODS: A preselected group of participants (n = 5) from the total sample of 16 participants with MS were asked to complete the revised MS-RS and Web-based journal writing for 20 minutes per day for 4 consecutive days over a 4-week period. Feasibility was evaluated by journal completion rates. RESULTS: Most participants found journal writing acceptable as a method for writing about symptoms. Participants were able to write about symptoms that formed clusters: unpredictable physical alterations and unpredictable sensory and emotional changes. Likewise, participants reported frequent fatigue, difficulty sleeping, heat intolerance, and difficulty concentrating/cognitive problems from the revised MS-RS. Disconcordance between revised MS-RS data and journal entries included lack of disclosure of difficulty sleeping and "pins and needles" in the journals. CONCLUSIONS: Preliminary findings from this study provide the personal perspectives of core symptoms experienced by adults with MS. These results provide preliminary evidence of the feasibility of journal writing, along with self-report survey, to describe symptoms in adults with MS.

Pilot Study of Videos to Deliver Mindfulness-Based Art Therapy for Adults With Multiple Sclerosis.

BACKGROUND: Mindfulness-based art therapy (MBAT) has been shown to provide a strategy for adults with multiple sclerosis (MS) to self-manage their symptoms. There is a need for the use of an MBAT intervention that can be delivered in any setting for adults with MS. The purpose of this pilot feasibility study was to test the feasibility and acceptability of an MBAT intervention delivered via videoconference. METHODS: We developed an MBAT intervention to be delivered by videoconference to adults with MS recruited from an academic center registry. We also conducted phone interviews to collect acceptability data. RESULTS: Most of the participants (n = 5) were very positive about the MBAT video sessions and stated content as clear and easy to follow and understand. The time and delivering method were acceptable. CONCLUSION: Mindfulness-based art therapy sessions delivered through videoconference are acceptable and feasible for adults with MS.

Effectiveness of mindfulness-based art therapy for symptoms of anxiety, depression, and fatigue: A systematic review and meta-analysis.

BACKGROUND AND PURPOSE: Many people with chronic medical conditions experience symptoms that are complex and negatively impact their quality of life (QOL). This review and meta-analysis examined the benefits of mindfulness based art therapy (MBAT) to relieve symptoms. METHODS: Included were studies that (a) evaluated an MBAT intervention in adults, (b) included a sufficient effect size and control group, and (c) assessed symptoms and QOL outcomes. RESULTS: Fourteen studies sampling adolescents and adults met inclusion criteria. Participants who received MBAT interventions reported significant improvements in psychological and physical symptoms indices compared to controls; the meta-analysis MBAT interventions revealed a medium effect size whereas that for controls the effect size was equivalent to zero. CONCLUSION: MBAT is a promising intervention for symptom relief. However, the literature is limited by the small number of studies. Randomized controlled trials with larger samples are needed to validate findings.

The relationship between risk factors and medication adherence among breast cancer survivors: What explanatory role might depression play?

OBJECTIVE: Despite the efficacy of clinical treatments (eg, adjuvant hormonal therapy) for breast cancer survivors (BCS), nonadherence rates remain high, increasing the risk of recurrence and mortality. The current study tested a theoretical model of medical nonadherence that proposes depression to be the most proximal predictor of medical nonadherence among BCS. METHODS: Breast cancer survivors were recruited from radiation clinics in Missouri. Survey data were collected 12 months after the end of primary treatment. The sample size included 133 BCS. RESULTS: Findings show substantial support for the model, demonstrating that depression mediated the relation between physical symptoms, cognitive symptoms, social support, and adherence to medication. This finding was replicated with a measure of mood disturbance. CONCLUSIONS: These findings support the prediction that medication nonadherence among BCS multiply determined process and have compelling implications for healthcare providers and interventions designed to increase medication adherence among BCS.

Negatively valenced expectancy violation predicts emotionality: A longitudinal analysis.

We hypothesized that negatively valenced expectancy violations about the quality of 1's life would predict negative emotionality. We tested this hypothesis in a 4-wave longitudinal study of breast cancer survivors. The findings showed that higher levels of negatively valenced expectancy violation, at earlier time points, were associated with greater negative emotionality, at later time points. Implications of the findings are discussed. (PsycINFO Database Record

Explaining Extremity in Evaluation of Group Members: Meta-Analytic Tests of Three Theories.

A meta-analysis that included more than 1,100 effect sizes tested the predictions of three theoretical perspectives that explain evaluative extremity in social judgment: complexity-extremity theory, subjective group dynamics model, and expectancy-violation theory. The work seeks to understand the ways in which group-based information interacts with person-based information to influence extremity in evaluations. Together, these three theories point to the valence of person-based information, group membership of the evaluated targets relative to the evaluator, status of the evaluators' ingroup, norm consistency of the person-based information, and incongruency of person-based information with stereotype-based expectations as moderators. Considerable support, but some limiting conditions, were found for each theoretical perspective. Implications of the results are discussed.

Expectancy violations and the search for meaning among breast cancer survivors.

A number of theoretical perspectives suggest that expectancy violations (EVs) threaten a person's sense of meaning and prompt efforts to reinstate meaning. Yet, little to no research has explicitly examined whether EVs predict actual efforts to search for meaning. The current research redresses this gap in the literature among a sample of breast cancer survivors. The results revealed that EVs, but not life satisfaction, positively predicted the search for meaning. By comparison, the presence of meaning was predicted by both EVs and life satisfaction. Further, EVs predicted an increased search for meaning among participants who simultaneously believed that their life had high levels of meaning. Thus, personal EVs may offer a compelling framework for understanding what prompts searches for meaning.

Predictors of depressive symptoms among breast cancer patients during the first year post diagnosis.

It is important to identify predictors of psychological health among breast cancer patients that can be relatively easily identified by medical care providers. This article investigates the role of one class of such potential predictors: easily identified demographics that have potential social and/or practical implications. Specifically, we examined whether income, marital status, presence of children in the home, education, travel distance, age and rurality interact with time to predict psychological health over the first year post diagnosis. Two hundred and twenty five breast cancer patients receiving radiation treatment completed four surveys over the course of 13 months that included measures of both their physical health and depressive symptoms. The results revealed that women who were not married had children living in the home or had to travel long distances to receive radiation treatment reported higher levels of depressive symptoms across the entire study. Women with lower incomes reported increased depressive symptoms, but only after the completion of treatment. Younger women reported elevated depressive symptoms during initial treatment, but this effect dissipated after the completion of treatment. The current results suggest that demographic patient characteristics may indeed be useful in identifying both when and for whom depressive symptoms are particularly likely to be problematic.

Social roles, basic need satisfaction, and psychological health: the central role of competence.

The authors propose that competence need fulfillment within valued role domains (i.e., spouse, parent, worker) will account, in part, for associations between autonomy and relatedness need fulfillment and psychological health. Testing these assertions in cross-sectional and longitudinal surveys of women in two independent community samples, the findings are the first to formally examine whether the satisfaction of competence needs within social roles accounts for associations between other types of need satisfaction and affective outcomes as well as depressive symptomology. Evidence supporting the hypothesis was stronger when examining individuals' affective health as compared to their depressive symptoms. Implications of the findings are discussed with regard to need fulfillment within social roles.

Depression and medication adherence among breast cancer survivors: bridging the gap with the theory of planned behaviour.

Evidence suggests that more depressed breast cancer patients will less likely adhere to treatment plans. This study presents evidence that the theory of planned behaviour mediates the relation between depression and intentions to adhere to treatment plans and between depression and lack of adherence to medication regime. Two hundred and thirteen women undergoing breast cancer treatment participated in this study. Measures of depressive symptoms and planned behaviour variables were collected at the first time point; measures of medication adherence were collected at the second time point. Structural equation models were utilised to fit the data to the proposed models. Depressive symptoms were significantly correlated to both intentions and medication adherence. In support of hypotheses, the relation between depressive symptoms and treatment intention was mediated by attitudes towards health maintenance plans. The relation between depressive symptoms and medication adherence was fully mediated by the planned behaviour process. Conditions under which treatment intentions and perceptions of control in adhering to treatment were most related to medication adherence were elucidated. The results point to avenues for interventions to increase medication adherence among breast cancer patients. Manipulating attitudes and perceptions of control towards treatment plans will potentially serve to increase medication adherence.

The feasibility and effectiveness of expressive writing for rural and urban breast cancer survivors.

PURPOSE/OBJECTIVES: To determine the feasibility and effectiveness of implementing an in-home expressive-writing intervention among breast cancer survivors living in urban and rural areas. DESIGN: Women who had completed radiation therapy were selected to participate in either expressive writing or a usual-care control condition. SETTING: All materials were completed in the privacy of participants' homes. SAMPLE: Of the 57 breast cancer survivors recruited, 40 participated in the writing intervention. An additional 40 women were assigned to the control group. METHODS: Participants completed measures of physical and psychological health at two time points prior to writing and at two follow-up time points three and nine months after writing. MAIN RESEARCH VARIABLES: Participation rates and physical and psychological health. FINDINGS: Results showed that engaging in a single in-home writing session for women with breast cancer was feasible and showed significant improvements in physical and psychological health compared to control three months (but not nine months) after writing. Although no difference was found in effectiveness of the intervention between women living in urban versus rural areas, rural women showed slightly higher participation rates. CONCLUSIONS: The results illustrate the utility of employing remotely administered expressive-writing interventions for breast cancer survivors. IMPLICATIONS FOR NURSING: Healthcare professionals who wish to use writing to facilitate improvements in their patients may suggest that patients write at multiple time points, offer for the intervention to be completed at home, and target rural populations in particular.

Rural breast cancer patients, coping and depressive symptoms: a prospective comparison study.

Many studies have revealed that individual differences in coping responses to the diagnosis and treatment of breast cancer are associated with psychological adjustment. The vast majority of these studies, however, focus exclusively on urban breast cancer survivors despite that rural breast cancer survivors are likely to have distinct experiences both in general and in relation to breast cancer. The current study quantitatively examined the coping strategies employed by both rural and urban breast cancer patients while they were undergoing radiation therapy. Further, the influence of these coping behaviours on concurrent as well as subsequent depressive symptoms (3 and 6 months later) was examined. The results revealed that the rurality of breast cancer patients was unrelated to the ways in which they coped, but did influence the relationships between some coping responses and depressive symptoms. Specifically, active coping and positive reinterpretation were negatively related to depressive symptoms for more rural breast cancer patients, but not their relatively urban counterparts. Similarly, behavioural disengagement was more strongly related to depressive symptoms for more rural patients. Possible reasons for this pattern of results and implications are discussed.

Rural and urban breast cancer patients: health locus of control and psychological adjustment.

OBJECTIVE: This study examines the moderating influence of rural residence on the associations between health locus of control (HLC) beliefs and psychological well-being. METHOD: Two hundred and twenty-four breast cancer patients were surveyed. RESULTS: The results revealed that rurality interacted with HLC beliefs in predicting psychological adjustment. The pattern indicated that, whereas endorsing external forms of locus of control can be detrimental to the psychological well-being of urban breast cancer patients, the same is not true for rural breast cancer patients. For rural breast cancer patients, powerful others locus of control was beneficial for and chance locus of control was unrelated to well-being. CONCLUSIONS: Implications for future research and medical care are discussed.

The breast cancer experience of rural women: a literature review.

This report is a review of studies that focus on rural breast cancer survivorship. It includes a total of 14 studies using large databases and 27 other studies using qualitative and quantitative methods. In our review of this literature, we identified four broad themes, including access to treatment and treatment type, medical providers and health information, psychosocial adjustment and coping, and social support and psychological support services. We review the findings of the rural breast cancer survivorship studies within each of these broad themes. A few of the findings of the review include that rural and urban women receive different primary treatments for breast cancer, that rural women may have greater difficulty negotiating their traditional gender roles during and after treatment, that rural women desire greater health-related information about their breast cancer, and that rural women have less access to mental health therapy. The review discusses the implications of these findings as well as the weakness in the literature.

Satisfaction with health care, psychological adjustment, and community esteem among breast cancer survivors.

The present survey study examines whether satisfaction with health care predicts breast cancer patients' psychological adjustment and esteem for their communities. Forty-nine women undergoing radiation therapy for breast cancer completed measures of satisfaction with health care, psychological well-being, community esteem, depression, perceived health status, and demographics. As predicted, the results showed that breast cancer survivors' satisfaction with their health care was predictive of their psychological well-being even when controlling for relevant variables such as depression and health status. Also, breast cancer survivors' satisfaction with their health care predicted their level of community esteem. These findings are discussed in terms of their implications for the psychological adjustment of breast cancer survivors.

Personality and aggressive behavior under provoking and neutral conditions: a meta-analytic review.

The authors conducted a comprehensive review to understand the relation between personality and aggressive behavior, under provoking and nonprovoking conditions. The qualitative review revealed that some personality variables influenced aggressive behavior under both neutral and provocation conditions, whereas others influenced aggressive behavior only under provocation. Studies that assessed personality variables and that directly measured aggressive behavior were included in the quantitative review. Analyses revealed that trait aggressiveness and trait irritability influenced aggressive behavior under both provoking and neutral conditions but that other personality variables (e.g., trait anger, Type A personality, dissipation-rumination) influenced aggressive behavior only under provoking conditions. The authors discuss possible relations between these patterns of aggressive behavior and the personality dimensions of Agreeableness and Neuroticism and consider implications for theories of aggression.